Repeated vertebral augmentation for new vertebral compression fractures of postvertebral augmentation patients: a nationwide cohort study

Figures & data

Table 1 Total 79,225 patients undergoing first vertebral augmentation

	First vertebral augmentation	Second vertebral augmentation
2004	12,573	1,759 (13.9%)
2005	15,261	2,080 (13.6%)
2006	22,076	2,351 (10.6%)
2007	29,315	2,743 (9.4%)
Total	79,225	8,933 (11.3%)

Table 2 Baseline characteristics and comorbidities of 79,225 patients

Variables	Underwent 2nd vertebral augmentations (n=8,933)	Did not undergo 2nd vertebral augmentation (n=70,292)	P-value
Age
45–49	53 (0.6%)	492 (0.7%)	0.388
50–54	205 (2.3%)	1,757 (2.5%)	0.261
55–59	447 (5.0%)	4,499 (6.4%)	0.417
60–64	572 (6.4%)	5,834 (8.3%)	0.220
65–69	822 (9.2%)	9,489 (13.5%)	0.065
70–74	1,501 (16.8%)	13,355 (19.0%)	0.084
75–79	1,974 (22.1%)	16,167 (23.0%)	0.254
≥80	3,359 (37.6%)	18,699 (26.6%)	0.003*
Sex, female	6,110 (68.4%)	36,692 (52.2%)	0.002*
Diabetes mellitus	3,171 (35.5%)	14,480 (20.6%)	0.029*
Hypertension	2,626 (29.4%)	13,707 (19.5%)	0.026*
Hyperlipidemia	1,715 (19.2%)	7,732 (11.0%)	0.013*
Coronary heart disease	1,635 (18.3%)	10,825 (15.4%)	0.670
Myocardial infarction	304 (3.4%)	2,038 (2.9%)	0.331
Peripheral vascular disease	366 (4.1%)	3,023 (4.3%)	0.129
Cerebrovascular disease	858 (9.6%)	2,038 (2.9%)	0.002*
Arthritis or other arthropathy	268 (3.0%)	1,828 (2.6%)	0.475
Chronic respiratory disease	98 (1.1%)	633 (0.9%)	0.395
Chronic renal insufficiency	366 (4.1%)	2,671 (3.8%)	0.498
Dementia	1,027 (11.5%)	2,038 (2.9%)	0.002*
Blindness or low vision	554 (6.2%)	1,546 (2.2%)	0.012*
Osteoporosis	4,556 (51.0%)	29,944 (42.6%)	0.056

Note:

* P<0.05.

Table 3 Medication exposure in patients undergoing repeat vertebral augmentation and in those not undergoing repeat vertebral augmentation

Variables	Repeat vertebral augmentation (n=8,933)	No repeat vertebral augmentation (n=70,292)	P-value
Calcium/vitamin D	2,224 (24.9%)	26,360 (37.5%)	0.025*
Bisphosphonates	1,581 (17.7%)	25,586 (36.4%)	0.011*
Hormone replacement therapy	813 (9.1%)	7,240 (10.3%)	0.308
Selective estrogen receptor modulators	1,108 (12.4%)	9,489 (13.5%)	0.121
Calcitonin	947 (10.6%)	15,253 (21.7%)	0.010*
Steroids	2,993 (33.5%)	7,592 (10.8%)	0.009*
Acetaminophen	2,555 (28.6%)	8,084 (11.5%)	0.006*
NSAIDs	3,100 (34.7%)	11,528 (16.4%)	0.005*
Antidepressants	759 (8.5%)	5,412 (7.7%)	0.363
Stimulants	607 (6.8%)	4,850 (6.9%)	0.275
Antipsychotics	295 (3.3%)	1,968 (2.8%)	0.514
Mood stabilizers	250 (2.8%)	1,757 (2.5%)	0.448
Anxiolytics	286 (3.2%)	2,109 (3.0%)	0.427

Note:

* P<0.05.

Abbreviation: NSAID, nonsteroidal anti-inflammatory drug.

Table 4 Risk factors for undergoing repeat vertebral augmentation

	Univariate analysis			Multivariate analysis
	Unadjusted OR	95% CI	P-value	AOR	95% CI	P-value
Age (years)	1.27	1.19–1.50	0.030*	1.60	1.31–2.08	0.011*
Sex	1.19	1.03–1.87	0.019*	1.24	1.10–2.36	0.008*
Diabetes mellitus	3.75	2.39–4.29	0.017*	4.31	4.05–5.88	0.001*
Hypertension	1.94	1.09–2.36	0.021*	2.58	2.35–3.47	0.009*
Hyperlipidemia	1.69	1.02–2.06	0.034*	2.09	1.67–2.22	0.015*
Coronary heart disease	0.31	0.05–0.69	0.660	0.42	0.17–0.56	0.892
Myocardial infarction	0.81	0.54–0.94	0.826	0.93	0.60–1.27	0.356
Peripheral vascular disease	0.40	0.25–0.79	0.115	0.54	0.19–0.78	0.534
Cerebrovascular disease	3.12	1.27–3.97	0.026*	4.09	3.44–5.76	0.003*
Arthritis and other arthropathy	0.77	0.27–1.20	0.221	0.85	0.33–1.89	0.530
Chronic respiratory disease	0.22	0.03–0.54	0.611	0.49	0.38–0.67	0.397
Chronic renal insufficiency	0.15	0.04–0.59	0.729	0.24	0.13–0.40	0.408
Dementia	1.77	1.23–2.08	0.011*	1.97	1.69–2.33	0.002*
Blindness and low vision	2.09	1.58–2.54	0.025*	3.72	2.32–3.95	0.002*
Osteoporosis	0.33	0.18–0.86	0.253	0.59	0.25–0.71	0.772
Calcium/vitamin D	1.72	1.18–2.11	0.020*	2.98	1.83–3.93	0.008*
Bisphosphonates	1.30	1.05–1.80	0.034*	2.11	1.26–2.61	0.016*
Hormone replacement therapy	0.28	0.11–0.90	0.255	0.31	0.14–0.85	0.408
Selective estrogen receptor modulators	0.73	0.64–0.93	0.723	0.95	0.80–1.02	0.492
Calcitonin	2.94	1.11–3.80	0.035*	4.59	3.40–5.77	0.017*
Steroids	5.42	3.63–6.48	0.015*	7.28	6.32–8.08	0.009*
Acetaminophen	2.48	1.05–3.09	0.026*	3.54	2.75–4.83	0.006*
NSAIDs	4.55	3.28–7.34	0.038*	6.14	5.08–7.41	0.005*
Antidepressants	0.68	0.53–0.93	0.947	0.76	0.49–0.95	0.616
Stimulants	0.89	0.23–0.98	0.526	0.91	0.25–1.13	0.397
Antipsychotics	0.94	0.71–1.41	0.911	0.78	0.47–0.92	0.733
Mood stabilizers	0.44	0.09–0.92	0.318	0.53	0.42–0.81	0.630
Anxiolytics	0.33	0.04–0.78	0.554	0.36	0.14–0.55	0.476

Notes: Odds ratios were adjusted for age, sex, DM, hypertension, hyperlipidemia, coronary heart disease, myocardial infarction, peripheral vascular disease, cerebrovascular disease, arthritis and other arthropathy, chronic respiratory disease, chronic renal insufficiency, dementia, blindness and low vision, osteoporosis, calcium/vitamin D, bisphosphonates, hormone replacement therapy, selective estrogen receptor modulators, calcitonin, steroids, acetaminophen, NSAIDs, antidepressants, stimulants, antipsychotics, mood stabilizers, and anxiolytics.

* P<0.05.

Abbreviations: CI, confidence interval; DM, diabetes mellitus; NSAID, nonsteroidal anti-inflammatory drug; AOR, adjusted odds ratio; OR, odds ratio.

Figure 1 Kaplan–Meier survival curve of overall repeat vertebral augmentations.

Figure 2 The frequency with which patients underwent a second procedure was particularly high in patients ≥80 years of age.